AAP Details Principles in Child Health Care Financing

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Existing benefits in health care coverage should be safeguarded and expanded to reach all children

The American Academy of Pediatrics (AAP), in an urgent response to proposed changes to the health care system, published a policy statement that supports maintaining the structure of the
Medicaid program, including the expansion, and opposes any sacrifice in gains made toward providing comprehensive, high-quality and affordable health care for all U.S. children.

The AAP policy statement, "Principles of Child Health Care Financing," will appear in the September 2017 print issue of
Pediatrics but will be published online July 17. The statement affirms the belief that public and private health care insurance should safeguard existing benefits for all infants, children, adolescents, and young adults through age 26. The Academy recommends taking additional steps to further reduce uninsurance rates, ensure coverage of essential benefits, and remove operational barriers to timely access to care.

"Our first principle as physicians is to do no harm," said AAP President Fernando Stein, MD, FAAP. "The long-term costs to society will be much higher if we don't provide essential care for our youngest, most vulnerable populations today."

More children and young adults have become insured since passage of the Affordable Care Act (ACA) than at any time since the creation of the Medicaid program in 1965. Since the ACA became law in 2010, the uninsurance rate for children younger than 18 has dropped from 9.7% to 4.8%. This historic reduction in the number of uninsured children is in large part because the Medicaid program, the
Children's Health Insurance Program (CHIP), and key ACA changes in employer-sponsored and marketplace health plans have worked together in a coordinated way. Current congressional and Administration proposals will reverse this progress, leading to higher rates of uninsured children, lower levels of needed benefits, and reduced access to developmentally appropriate care throughout the full span of childhood.

At the same time, the United States has benefited from advances in pediatric health care, resulting in decreased infant mortality, increased immunization rates, and a decline in the rate of preventable hospital admissions for children.

"As a country, we have made incredible strides over the past decade in reducing the number of children without health insurance by over 50%, in increasing the coverage of essential benefits for children, and in making insurance affordable to families and children who could not previously obtain coverage. We simply cannot afford and must vigorously oppose relinquishing these gains so as not to harm children," said Mark L. Hudak, MD, FAAP, a lead author of the report. "The United States can and should do more to make sure that no child lacks access to necessary health care."

In its policy statement, the AAP calls for Congress to improve the patchwork of public and private insurance programs, expand Medicaid funding to ensure the continued access to the 37 million children who rely on this program, and extend funding for CHIP for five more years. CHIP covered 8.9 million children in fiscal year 2016 alone, the statement observes.

According to the AAP, a comprehensive health care system should include these goals:

Universal, quality, and affordable health insurance for all who live in the United States, regardless of income, family composition, or immigration status, from birth through 26 years of age.

Coverage of essential pediatric benefits. These include but are not limited to prenatal and newborn care; postnatal home visits; preventive and wellness services; urgent and emergency care; and services for dental treatments, behavioral and mental health care, reproductive health, and treatment of substance abuse disorders.

"Cost-sharing" expenses [copayments, deductibles and coinsurance charges] that are structured to enable preventive care, encourage wise use of other medical care, and are affordable in relation to family income.

Adequate provider payments to strengthen the medical home and help physicians coordinate services and care.

"Reforms aimed solely at cutting costs for health care will harm children," Dr. Stein said. "We should evaluate what works or doesn't work in the current model and focus on improving the system where it has short-comings. This will require a thoughtful, comprehensive approach."